Non-Invasive Indirect Markers of Liver Fibrosis after Interferon-Free Treatment for Hepatitis C

The effectiveness of interferon-free therapy during the course of HCV infection has already been confirmed. Liver fibrosis can be assessed in several ways, from biopsies to imaging tests. The present study evaluates the usefulness of non-invasive indirect biomarkers of liver fibrosis (APRI, GAPRI, FORNS, FIB-4, the AP index and HUI score) as markers of the effective treatment of HCV with the 3D regimen. Blood samples were collected from 70 patients suffering from chronic hepatitis C. Patients received the 3D AbbVie regimen for hepatitis C. All patients had HCV genotype 1b. The APRI, GAPRI, FIB-4, FORNS, HUI and AP index (age–platelet score) values were calculated with their respective algorithms. The stage of fibrosis was evaluated on the basis of a liver biopsy and confirmed by FibroScan-based transient elastography. An undetectable level of HCV RNA after 12 weeks of treatment with the 3D regimen indicates 100% eradication of hepatitis C virus. After the treatment, non-invasive indirect markers of liver fibrosis achieved levels below the limit for significant fibrosis, Thus, non-invasive indirect biomarkers of hepatic fibrosis failed to detect the presence of significant fibrosis, which was proved in histopathological examination. However, the eradication of hepatitis C virus by means of the 3D regimen treatment does not mean that patients were completely cured.

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The impact of direct-acting antivirals on liver fibrosis in Egyptian hepatitis C virus patients: a single center experience

QJM ◽

10.1093/qjmed/hcab107.007 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nadia Abdelaaty Abdelkader ◽

Amira Mahmoud AlBalakosy ◽

Ahmed Fouad Helmy Sherief ◽

Mohamed Soliman Gado

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Liver Fibrosis ◽

Transient Elastography ◽

Liver Stiffness ◽

Treatment Unit ◽

Non Invasive ◽

One Year ◽

The Impact

Abstract Background Hepatitis C virus (HCV) infection affects approximately 170 million people worldwide, causing liver cirrhosis and hepatocellular carcinoma (HCC) and leading to liver transplantation and ultimately death. Accurate evaluation of liver fibrosis in patients with chronic liver diseases is crucial, as liver fibrosis is important in order to make therapeutic decisions, determine prognosis of liver disease and to follow-up disease progression. Multiple non-invasive methods have been used successfully in the prediction of fibrosis; however, early changes in noninvasive biomarkers of hepatic fibrosis under effective antiviral therapy are widely unknown. The aim of this study is to evaluate changes of transient elastography values as well as FIB-4 and AST to platelet ratio index (APRI) in patients treated with DAAs. Objectives The aim beyond this study is to evaluate the changes in liver stiffness in hepatitis C Egyptian patients before and at least one year after treatment with DAAs using transient elastography and non-invasive liver fibrosis indices as FIB-4 and APRI scores. Patients and methods The present study was conducted on 100 patients with chronic hepatitis C patients attended to Ain Shams University Hospitals, Viral hepatitis treatment unit between October 2017 and December 2018, who were followed-up during treatment and after treatment for at least one year (retrospective and prospective study). Total number of cases during the study period was 117 patients. 17 patients were excluded from the study due to missed follow-up. Eventually, 100 patients were enrolled in the study fulfilling the inclusion criteria. Results The mean age of our patients is 47.9 years with Male predominance (52 males and 48 females). There was a significant improvement of, platelets counts, ALT and AST levels, which in turn cause significant improvement in FIB-4 and APRI scores. There was a significant improvement of liver stiffness after end of treatment, regardless of the DAA regimen used, as evidenced by Fibroscan. Conclusion Fibrosis regression –assessed by non-invasive markers of fibrosis is achievable upon removal of the causative agent.

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Real time ultrasound tissue Elastography in post-hepatitis chronic liver disease; role, limitations and pitfalls

QJM ◽

10.1093/qjmed/hcab106.071 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Noha M Diaa ◽

Merhan A Nasr ◽

Mohamed M Mohamed ◽

Shimaa M Radwan

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Biopsy ◽

Real Time ◽

Transient Elastography ◽

Chronic Liver ◽

P Value ◽

Hcv Rna ◽

Significant Fibrosis ◽

Non Invasive

Abstract Assessment of liver fibrosis stage is important in determining the prognosis and treatment strategy in chronic liver diseases. To overcome the limitations of liver biopsy, great efforts have been made to develop and validate non-invasive methods for detecting liver fibrosis, including serological indicators and imaging methods. Among these noninvasive methods, ultrasound-based elastography techniques are increasingly employed to assess parenchymal stiffness. Real-time transient elastography is most accurate one of them and rapidly evolving technique that can reveal the elastic properties of tissues, and display it as real time images. This technique can avoid unnecessary invasive liver biopsy. Patients and methods This descriptive study was done on 20 chronic HCV patients as diagnosed by seropositivity for HCV antibodies and HCV RNA by PCR, Patients were recruited from police hospitals outpatient clinics to find an alternative method to assess liver fibrosis. Results showed highly significant agreement between fibroscan scores and biopsy results (p value was < 0.001), the identification of patients with significant fibrosis (F ≥ 2) “F2, 3, 4” We reported that the cut off level of significant fibrosis (F ≥ 2) assessed by the METAVIR scoring system was 10.2 kpa, with sensitivity 86.7 % and specificity 80 %. However, cut-off level of 13.8 kpa for the detection of cirrhosis (F4) with an area under the ROC of 0.913, and a very high sensitivity and specificity (sensitivity 90.1% and specificity 85.7%). Conclusion Transient Elastography is an easy and quick clinical non-invasive method to perform. Results are available immediately, and this technique is accurate in predicting significant fibrosis ≥f2. Hence, Transient Elastography could be useful not only to evaluate liver fibrosis as to monitor liver disease progression, but also to monitor anti-viral or antifibrotic therapy effects and to help taking decisions in daily clinical practice.

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Non-invasive serum markers and transient elastography in staging advanced chronic hepatitis C

Acta medica Lituanica ◽

10.6001/actamedica.v22i4.3237 ◽

2016 ◽

Vol 22 (4) ◽

pp. 188-195

Author(s):

Arida Buivydienė ◽

Viktorija Basytė ◽

Jonas Valantinas

Keyword(s):

Hepatitis C ◽

Liver Fibrosis ◽

Transient Elastography ◽

Histopathological Examination ◽

Rank Correlation ◽

Serum Markers ◽

Gamma Glutamyl Transferase ◽

Hepatitis C Infection ◽

Non Invasive ◽

Glutamyl Transferase

Objectives. In the past decade researchers are presenting indirect non-invasive serum markers for liver fibrosis and cirrhosis evaluation. Our aim was to evaluate effectiveness in staging advanced liver disease when using transient elastography and nine non-invasive serum markers: APRI, FIB-4, ASPRI, LSPS, P2/MS, FibroQ, Fibro-α, Pohl, CDR. Methods. 162 patients with hepatitis C infection were included in this study. Patients were divided in two groups, regarding histopathologic results: advanced liver fibrosis and cirrhosis. The following laboratory measures were obtained in all patients: ALT, AST, albumin, total bilirubin, alkaline phosphatase, gamma glutamyl transferase, INR, hemoglobin, platelet count, alfa fetoprotein, segmented neutrophils count and percentage and monocytes percentage. Transient elastography and nine non-invasive serum markers – APRI, FIB-4, ASPRI, LSPS, P2/MS, FibroQ, Fibro-α, Pohl, CDR – were compared with the results of the histopathological examination. A statistical analysis was done using the Student t-test, the Spearman’s rank correlation and the area under receiver-operating characteristic curves (AUROCs). Results. All nine non-invasive markers correlated significantly with the liver fibrosis stage (P

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Evaluation of Liver Fibrosis by FibroScan in β-Thalassemia Children Infected with Hepatitis C Virus Before and After Ledipasvir/Sofosbuvir Therapy

International Blood Research & Reviews ◽

10.9734/ibrr/2020/v11i330130 ◽

2020 ◽

pp. 9-17

Author(s):

Aya Lotfy Yosef ◽

Hanan Hamed Soliman ◽

Gamal El-Sayed Shiha ◽

Mohiee El-Deen AbdEl-Aziz Awad ◽

Eslam El-Sayed El-Hawary

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Liver Fibrosis ◽

Transient Elastography ◽

Liver Stiffness ◽

Hcv Infection ◽

University Hospital ◽

P Value ◽

Non Invasive ◽

Before And After

Background: Thalassemic children develop liver fibrosis because of liver iron overload and hepatitis C virus (HCV) infection. Transient elastography (FibroScan) can be a reliable non-invasive method for evaluating liver fibrosis in thalassemic patients. Treatment with ledipasvir/sofosbuvir (LED/SOF) direct acting antiviral agents can significantly affect liver stiffness measurement (LSM) by FibroScan. Aims: To assess liver fibrosis by non-invasive FibroScan through LSM before and after generic LED/SOF therapy in multi-transfused β-thalassemic children infected with HCV. Place and Duration of Study: Pediatric Hematology Unit, Tanta University Hospital, from November 2017 to May 2019. Methodology: Fifty multi-transfused β-thalassemic treatment-naϊve children (aged 12-18 years and weighing ≥35kg) with chronic HCV infection were subjected to clinical evaluation, quantitative HCV PCR assay, FibroScan examination, and calculation of APRI, FIB4 index and AST/ ALT ratio. In addition to standard therapy, generic LED/SOF (90/400 mg) treatment was given for 12 weeks’ duration with follow up for further 12 weeks after end of treatment. Results: A positive HCV PCR was changed into negative for all studied patients starting from week 4 after treatment. There was highly significant reduction in the LSM values by FibroScan in the studied patients after therapy (p-value <0.001) with median reduction of 19.4 %. The significant reduction in LSM values was particularly prominent in patients with significant (F2) and advanced (F3) liver fibrosis stages as well as cirrhotic patients (F4). There was significant reduction in the values of other non-invasive liver fibrosis markers FIB-4 index, APRI score and AST/ ALT ratio (p-value <0.001, <0.001 and 0.020 respectively) after therapy. Conclusion: Generic LED/SOF therapy for 12 weeks’ duration resulted in eradication of HCV infection that was associated with significant decrease in LSM by FibroScan particularly those with higher baseline liver fibrosis stages.

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Lack of short-term increase in serum mediators of fibrogenesis and in non-invasive markers of liver fibrosis in HIV/hepatitis C virus-coinfected patients starting maraviroc-based antiretroviral therapy

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-012-1546-5 ◽

2012 ◽

Vol 31 (8) ◽

pp. 2083-2088 ◽

Cited By ~ 11

Author(s):

J. Macías ◽

◽

M. M. Viloria ◽

A. Rivero ◽

I. Santos ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Antiretroviral Therapy ◽

Liver Fibrosis ◽

Short Term ◽

Non Invasive

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Early changes in non-invasive assessment of liver fibrosis in hepatitis C virus-infected patients treated with DAAs: Preliminary reports

Digestive and Liver Disease ◽

10.1016/j.dld.2016.07.035 ◽

2016 ◽

Vol 48 ◽

pp. e238-e239

Author(s):

C. Iegri ◽

L. Pasulo ◽

M. Colpani ◽

A. Baldan ◽

G. Magini ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Liver Fibrosis ◽

Non Invasive

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Significance of biglycan and osteopontin as non-invasive markers of liver fibrosis in patients with chronic hepatitis B virus and chronic hepatitis C virus

Journal of Investigative Medicine ◽

10.1136/jim-2018-000840 ◽

2018 ◽

Vol 67 (3) ◽

pp. 681-685 ◽

Cited By ~ 1

Author(s):

Ali Sobhy ◽

Mohammed Fakhry M. ◽

Haitham A Azeem ◽

Ahmed M Ashmawy ◽

Hamed Omar Khalifa

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Hepatitis B Virus ◽

Liver Fibrosis ◽

Hepatitis B ◽

Chronic Hepatitis C ◽

Chronic Hepatitis B ◽

Non Invasive ◽

B Virus

Several studies were performed to evaluate the degree of liver fibrosis by non-invasive markers. We aimed to assess the diagnostic value of both biglycan (BGN) and osteopontin (OPN) as non-invasive markers of hepatic fibrosis in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). This study was performed on 100 patients with CHB virus, 100 patients with CHC virus and 100 normal controls. All participants were subjected to the following laboratory tests: hemoglobin, platelet, alanine aminotransferase, aspartate aminotransferase, albumin, international normalized ratio, HBs Ag, hepatitis C virus (HCV) antibody, hepatitis B virus DNA, HCV RNA, liver biopsy, BGN and OPN. We found that BGN level was significantly increased in the CHB group compared with the controls (p<0.001), but the level was not different between the CHC group and the controls (p<0.96). OPN was increased in both the CHB and CHC groups compared with the controls (p<0.001). Positive correlation was found between fibrosis stages and BGN level of the CHB group (r=0.64; p<0.001) and between fibrosis stages and OPN level of the CHB (r=0.63; p<0.001) and CHC (r=0.59; p<0.03) groups. The area under the curve (AUC), sensitivity and specificity of BGN were 1.0, 100% and 100% in predicting fibrosis in patients with CHB, and 0.50, 26% and 78% in predicting fibrosis in patients with CHC. OPN had an AUC of 0.997, sensitivity of 96% and specificity of 100% in predicting fibrosis in patients with CHB, and 0.974, 96.5% and 100% in predicting fibrosis in patients with CHC. In conclusion, BGN and OPN could be considered non-invasive markers for liver fibrosis assessment.

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Baseline Amino Acid Substitutions in the NS5A ISDR and PKR Binding Domain of Hepatitis C and Different Fibrosis Levels and Levels of Development of Hepatocellular Carcinoma in Patients Treated with DAAs

Viruses ◽

10.3390/v12030255 ◽

2020 ◽

Vol 12 (3) ◽

pp. 255

Author(s):

Stefania Paolucci ◽

Antonio Piralla ◽

Federica Novazzi ◽

Alice Fratini ◽

Renato Maserati ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis C ◽

Liver Fibrosis ◽

High Frequency ◽

Transient Elastography ◽

Hcv Rna ◽

Amino Acid Substitutions ◽

Advanced Fibrosis ◽

Ns5a Region ◽

Advanced Liver Fibrosis

Variations in the interferon sensitivity-determining region (ISDR) within the NS5A region were related to the development of hepatocellular carcinoma (HCC) in patients infected with hepatitis C virus (HCV). The aim of the study was to investigate a relationship between ISDR/PKR substitutions and their association with liver fibrosis or HCC development. A total of 316 patients infected with HCV and treated with DAAs were evaluated. HCV RNA was quantified and sequenced before treatment. The liver fibrosis stage was assessed by transient elastography and equalized to METAVIR scores. Multivariate analysis showed that ≥3 substitutions in ISDR and ≥6 in PKR-bd were significantly associated with advanced fibrosis. Advanced fibrosis was observed in patients with higher substitutions in ISDR and PKR-bd. A higher correlation between advanced fibrosis and a high frequency of ≥3 substitutions in ISDR and ≥6 in PKR-bd was observed in patients infected with genotype 2c. In addition, in a higher proportion of HCC patients, advanced fibrosis (40.4% vs. 88.2%; p < 0.001) and ≥6 substitutions in PKR-bd (15.4% vs. 41.2%; p = 0.01) was observed. In conclusion, a higher number of substitutions in ISDR and PKR-bd were associated with advanced liver fibrosis, suggesting a use of like predictors for progression in the liver damage. A significantly higher number of PKR-bd substitutions was observed in HCC patients; in particular, in patients infected with HCV genotype 2c.

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